Valium for vertigo?

[zzyzx]

I was reading through another county's protocols, and they had one for vertigo. They suggest the use of valium. Anyone out there familiar with this? I suppose it makes sense.

They also suggest the use of Benadryl as an adjunct for anti-emetics, or by itself if anti-emetics are contraindicated.

[logos]

I was reading through another county's protocols, and they had one for vertigo. They suggest the use of valium. Anyone out there familiar with this? I suppose it makes sense.

They also suggest the use of Benadryl as an adjunct for anti-emetics, or by itself if anti-emetics are contraindicated.

I think most would consider anticholinergics 1st line for vertigo with benzos as second line.

Benadryl can be used as an anti-emetic (its also great for sleep and as an anxiolytic or for motion sickness or of course histamine mediated inflammatory reactions) Another drug in the same pharmacologic class as benadryl, phenergan, is used more commonly for nausea.

[Amhet1]

I know I have no problems with vertigo when I take valium..... I may fall down, but I dont care.

But on a more serious note, my guess (and it really is just a WAG), is that it may calm things in the inner ear releiving some of the vertigo. Or maybe they're so relaxed that they dont care they're dizzy.

As far as the Benadryl question, I was about to pull a reason outa my butt and check my references but they're packed up for the move. I did find this online tho....

from wikipedia: "Diphenhydramine (dye fen hye' dra meen) works by blocking the effect of histamine at H1 receptor sites. This results in effects such as the reduction of smooth muscle contraction, making diphenhydramine a popular choice for treatment of the symptoms of allergic rhinitis, hives, motion sickness, and insect bites and stings."

Since the stomach and intestines are smooth muscle, it makes sense that by calming a spasming stomach, there would be a decrease in emesis. Its just another WAG, but it makes sense to me.

[fishman]

I have seen Valium used for this working in E/R setting. Seems effective most of time. At least until a bigger cause can be found

[ERDoc]

Meclizine first, then valium and benadryl if needed.

[Doczilla]

Valium is not first-line therapy, but I have prescribed it when other drugs, like meclizine (Antivert) and scopolamine have failed. Meclizine and dramamine work on inner ear pathways in peripheral vertigo. Scopolamine has anticholinergic effects, and are thought to suppress brain pathways associated with vestibular function. Valium works on GABA receptors on many pathways in the brain, but we don't really know why it helps. Honestly, in people with vertigo refractory to other therapies, I've had none of them say that valium took it away. They do care a lot less about it, though.

Folks with head bleeds (traumatic) who get dizzy are generally dizzy no matter what you do. After the 5th call from the floor nurse, after meclizine, scop, benadryl, and valium, I order more valium so the poor sod can sleep.

'zilla

[Amhet1]

Does that script come with an extra 5mg valium for the nurse?

Hey doc, how close were my WAGs on the valium and benadryl?

[firedoc5]

Valium like that is new to me. Guess I could see it in-house and monitored, but not really in the field. And for some people Benadryl can make it worse. I know Benadryl wires me out and puts me on the ceiling. My understanding for vertigo is treating the underlying cause, ie. inner ear problems or sinus infection.

[Doczilla]

That's the problem with dizziness. So often the underlying "cause" is not something easily treatable. After looking in the ears, pike's maneuvers, CT head, CT angiogram or MRA of the cerebral circulation, electrolytes, thyroid panel, cardiac workup, etc., I shake my head as often as not. Most dizziness is not the result of an easily treatable condition, so we are left with the medications, which are very often not successful.

'zilla

[zzyzx]

Thanks for all your responses!

I understand that Valium is not a first-line treatment for vertigo, but would it be appropriate to give it pre-hospital to reduce the patient's discomfort?

More about Valium...what are your thoughts on treating agitated or delirious meth/coke OD's with Valium? How about Versed? I know this is done in the ER, but what about prehospital? Most Southern California counties have no protocols about using benzos for sedation, and I think most docs around here would be reluctant to allow such an order.